only1genevieve (![[info]](http://l-stat.livejournal.com/img/userinfo.gif){kind=small} only1genevieve) wrote,@ 2008-09-08 09:42:00 |
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Why I'm Slow On the Obama train...
I'm totally voting for Obama. I like Biden. Do I wish he had chosen Hillary as VP? Yes, but I knew he wouldn't, since she had that dust up with her campaign manager who went to the Obama camp. But at least I really like Biden's voting record.
On a side note, though, I said this before, and I'll say it again: Obama's health care plan sucks*. This is coming from a girl who grew up in her dad's pediatric office, working with her mother who did all of the business management and billing. His health care plan sucks. Not that McCain's is any better, it's not, but I can't really get fully behind Obama with this crap, "I'm in the pocket of insurance companies" health care plan (and he really is in the pocket of health insurance companies, as much as he says he's not). I hope he figures out an alternative, and fast.
Here are my major problems with it:
Buried in his policies on health care is a note on how they will insure quality health care from doctors by rewarding doctors who do things the right way and have positive outcomes. This has two problems:
1) Who decides what the "right way" is to do something, or what means a doctor is doing something correctly? My dad hired a young practitioner from back east. She came from clinic where the insurance companies forced them to have to prove they were doing things "right." This meant that, in reality, rather than trust her own judgment, she order tons and tons of lab tests - test she knew really wouldn't be necessary, but were necessary to leave a paper trail that showed she was doing it right. This wasn't just incredibly annoying to the patients, who felt it meant she didn't know anything, but it also drove up our costs - and the insurance company's costs- considerably. Plus, there are many "right ways" decided on by drug companies and insurance companies that really aren't so right. For example, you may have XYZ disease, which can be treated with drug 1, 2, and 3. For children, drug 3 is really the best because of certain factors, for adults with heart problems, drug 2 is best, and for otherwise healthy adults, drug 1 is best. But the drug and insurance companies will get together and pass policies that say doctors must use drug 1 on ALL patients with XYZ disease, period, and if they don't, then they are a "Bad doctor." (which, by the way, happened in my home town. Then, the insurance companies published a list of all "bad doctors" and mailed it to everyone in the town. Then, they refused to publish why the doctors were bad. Then it came out that doctors were bad for not prescribing certain medicines, which, incidentally, were the medicines that the insurance had deals on. Instead, the doctors were prescribing different, more expensive medicines.)
2) What is an "optimal outcome," or a "positive outcome"? The layman will say, "A patient who lives and is healthy." But in medicine, is that always possible? People are born with heart defects. People get terminal brain cancer. People get strange strains of tuberculosis that may or may not be treatable. These people do not have optimal outcomes. Really, what they want is a doctor who has time and energy to invest in making sure they have the right treatments to prolong their lives as much as possible, and make sure they are comfortable and healthy as possible. So what happens when they are placed in an optimal outcome situation?
They get dumped.
Outcome-based medicine is blind to the reality of the situation--it only sees the black and white numbers, who lives, who dies, and how much money did you spend on them. When outcome-based medicine reigns, practical doctors see that people with poor outlooks are a liability and they dump them as patients. It's terrible, but look at it from the doctor's point of view: He has to pay overhead for the practice, he has to pay malpractice insurance, and, until he's reimbursed from the government or insurance companies, he has to pay for all of the treatments for the patient out of his own pocket. If a patient doesn't have a positive outcome, the doctor will not be reimbursed as much - he will be lucky to break even, and mostly likely lose money on a patient with a poor outcome. Is it fair for the doctor to invest time, energy, and money into a patient with no prospect of reimbursement? No. But it's not fair for the patient not to get treatment, either. How would you feel if you got cancer, and went to the doctor, and the doctor wouldn't take you because they didn't feel your outlook was good and they had enough cancer patients already? What if your doctor wanted to treat you, but the clinic he was working for forbid him from doing so?
Outcome based medicine is something insurance companies want because they do not want to pay the costs of health care for patients with big problems. They'd rather doctors shunted these patients around until they died. It's horrible, but it's true. It's common practice for insurance companies to dick people around until they die, so they don't have to pay for chemotherapy or whatever other high-cost treatment the person needs.
Outcome based reimbursement for medicine is not "change," it's "death."
I'm totally voting for Obama. I like Biden. Do I wish he had chosen Hillary as VP? Yes, but I knew he wouldn't, since she had that dust up with her campaign manager who went to the Obama camp. But at least I really like Biden's voting record.
On a side note, though, I said this before, and I'll say it again: Obama's health care plan sucks*. This is coming from a girl who grew up in her dad's pediatric office, working with her mother who did all of the business management and billing. His health care plan sucks. Not that McCain's is any better, it's not, but I can't really get fully behind Obama with this crap, "I'm in the pocket of insurance companies" health care plan (and he really is in the pocket of health insurance companies, as much as he says he's not). I hope he figures out an alternative, and fast.
Here are my major problems with it:
Buried in his policies on health care is a note on how they will insure quality health care from doctors by rewarding doctors who do things the right way and have positive outcomes. This has two problems:
1) Who decides what the "right way" is to do something, or what means a doctor is doing something correctly? My dad hired a young practitioner from back east. She came from clinic where the insurance companies forced them to have to prove they were doing things "right." This meant that, in reality, rather than trust her own judgment, she order tons and tons of lab tests - test she knew really wouldn't be necessary, but were necessary to leave a paper trail that showed she was doing it right. This wasn't just incredibly annoying to the patients, who felt it meant she didn't know anything, but it also drove up our costs - and the insurance company's costs- considerably. Plus, there are many "right ways" decided on by drug companies and insurance companies that really aren't so right. For example, you may have XYZ disease, which can be treated with drug 1, 2, and 3. For children, drug 3 is really the best because of certain factors, for adults with heart problems, drug 2 is best, and for otherwise healthy adults, drug 1 is best. But the drug and insurance companies will get together and pass policies that say doctors must use drug 1 on ALL patients with XYZ disease, period, and if they don't, then they are a "Bad doctor." (which, by the way, happened in my home town. Then, the insurance companies published a list of all "bad doctors" and mailed it to everyone in the town. Then, they refused to publish why the doctors were bad. Then it came out that doctors were bad for not prescribing certain medicines, which, incidentally, were the medicines that the insurance had deals on. Instead, the doctors were prescribing different, more expensive medicines.)
2) What is an "optimal outcome," or a "positive outcome"? The layman will say, "A patient who lives and is healthy." But in medicine, is that always possible? People are born with heart defects. People get terminal brain cancer. People get strange strains of tuberculosis that may or may not be treatable. These people do not have optimal outcomes. Really, what they want is a doctor who has time and energy to invest in making sure they have the right treatments to prolong their lives as much as possible, and make sure they are comfortable and healthy as possible. So what happens when they are placed in an optimal outcome situation?
They get dumped.
Outcome-based medicine is blind to the reality of the situation--it only sees the black and white numbers, who lives, who dies, and how much money did you spend on them. When outcome-based medicine reigns, practical doctors see that people with poor outlooks are a liability and they dump them as patients. It's terrible, but look at it from the doctor's point of view: He has to pay overhead for the practice, he has to pay malpractice insurance, and, until he's reimbursed from the government or insurance companies, he has to pay for all of the treatments for the patient out of his own pocket. If a patient doesn't have a positive outcome, the doctor will not be reimbursed as much - he will be lucky to break even, and mostly likely lose money on a patient with a poor outcome. Is it fair for the doctor to invest time, energy, and money into a patient with no prospect of reimbursement? No. But it's not fair for the patient not to get treatment, either. How would you feel if you got cancer, and went to the doctor, and the doctor wouldn't take you because they didn't feel your outlook was good and they had enough cancer patients already? What if your doctor wanted to treat you, but the clinic he was working for forbid him from doing so?
Outcome based medicine is something insurance companies want because they do not want to pay the costs of health care for patients with big problems. They'd rather doctors shunted these patients around until they died. It's horrible, but it's true. It's common practice for insurance companies to dick people around until they die, so they don't have to pay for chemotherapy or whatever other high-cost treatment the person needs.
Outcome based reimbursement for medicine is not "change," it's "death."
